Appeal and Grievance Coordinator

CVS Health

. Intake, investigate, and resolve appeals, complaints, and grievances for all products .

Posted 9/15/2026full-timeRemote • IndiaJunior💰 $17 - $26 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in investigating and resolving appeals, complaints, and grievances while ensuring compliance with regulatory requirements. Proficient in analyzing claims processing and benefit language to support decision-making and improve operational efficiency.

Highest-signal resume keywords

Claims Processing ExperienceRegulatory AnalysisAnalytical SkillsCommunication SkillsCustomer Service

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claim PlatformsBenefit Language ResearchCompliance AnalysisPatient ManagementProduct DraftingSpecial InvestigationsProvider RelationsAudit ExperienceResearch and AnalysisAttention to Detail

Soft Skills

CollaborationDecision-MakingAdaptability

Tools & Technologies

Microsoft ExcelMicrosoft Word

Industry Keywords

AppealsComplaintsGrievancesClinical TerminologyRegulatory RequirementsAccreditation Requirements

About the role

Key responsibilities & impact

Intake, investigate, and resolve appeals, complaints, and grievances for all products
Coordinate responses from multiple business units for cases containing multiple issues
Research incoming electronic work items and reroute items that do not meet applicable criteria
Research plan design and certification of coverage to assess benefit or administrative denials
Research claim processing logic, member eligibility data, and billing/payment status before initiating appeals
Identify and research all components of member or provider/practitioner cases
Triage incomplete case components to subject matter experts in other business units
Coordinate final resolution communications to members or providers and close cases
Serve as a technical resource to colleagues on appeals, complaints, and grievance issues
Identify trends and emerging issues, report findings, and recommend potential solutions

Requirements

What you’ll need

High School or GED equivalent
1-2 years experience including claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service; or audit experience
Experience in reading or researching benefit language
Ability to meet demands of a high paced environment with tight turnaround times
Ability to make appropriate decisions based upon Aetna's current policies/guidelines
Collaborative working relationships
Thorough knowledge of member and/or provider appeals, complaints and grievance policies
Strong analytical skills focusing on accuracy and attention to detail
Knowledge of clinical terminology, regulatory and accreditation requirements
Excellent verbal and written communication skills
Computer literacy, including Excel and Microsoft Word
Some college preferred
Experience in research and analysis of claim processing a plus

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being